Packed red blood cell transfusions in critically ill infants and children: is it time for a restructive transfusion strategy?

Although a restrictive transfusion policy is being increasingly advocated during critical illness in the past few years, the optimal hemoglobin level for red blood cell [RBC] transfusions is not known in critically ill infants and children. We conducted a prospective comparative randomized trial to test the hypothesis that a restrictive RBC transfusion strategy would be as safe as liberal transfusion strategy in the pediatric intensive care unit [PICU]. The primary outcome measure was PICU mortality following randomization, three hundred and nine patients with a hemoglobin concentration

Extubation failure: a study of risk factors and outcomes in an Egyptian PICU

To determine failed extabation rate, risk factors, and consequences of extubation failure in paediatric intensive care unit [PICU] in Mansoura University Children's Hospital [MUCH]. Twelve-month prospective, observational clinical study. The study extended from Dec 2004 to Dec 2005. PICU in MUCH. Ninety two children [43 girls, 49 boys], age 1-S3, months were enrolled. Neonates, post surgery tracheostomy, non invasive ventilation and unplanned extubation were the exclusion criteria. Sixty six children were directly extubated from 2 level pressure ventilation and 26 children underwent a spontaneous breathing trial before extubation. The diagnoses were; respiratory conditions [n=41] cardiac conditions [n= 30], neurological conditions [n=18] and miscellaneous conditions [n=3]. The extubation failure rate was 25% [23/92]. Patients failing extubation had a longer mechanical ventilation prior to attempted extubation [p=.002], higher cumulative fluid balance [p= .001] and a lower serum K+ [p<.00l]. Logistic regression revealed only the last two variables independently predicted extubation failure. Among the 66 children with SET, tidal volume on spontaneous breaths and the fraction of mandatory minute volume to total minute volume were, with the previous three parameters, independent predictors of extubation failure. Children who failed extubation had higher mortality [43.5%] compared to 8.7% in the group with successful extubation [p<.001]. Survivors had a longer PICU stay in the failure group [median 14.5, IQR 8 days] compared to the success group [median 9, IQR 5 days] with p<.001. The variables associated with extubation failure have to be considered during extubation trying to reduce the high extubation failure rate. The burden of extubation failure needs to be evaluated in terms of ventilation days and financial cost